OCD and Eating Disorders: Unveiling Treatment Synergies with Dr. Alyssa Hertz

Join us on this enlightening episode of our podcast as Dr. Alyssa Hertz dives into the complexities of treating individuals with both Obsessive-Compulsive Disorder (OCD) and eating disorders. With her dual expertise, Dr. Hertz highlights the synergy between the treatment methodologies for these often co-existing conditions and provides clarity on the psychological underpinnings that they share. Listeners will gain valuable insights into effective therapeutic practices, the importance of integrated care, and the role of psychoeducation in treatment. This episode is packed with practical advice for clinicians, uplifting success stories, and essential resources for anyone navigating the landscape of OCD and eating disorders. Tune in to empower your understanding and treatment approaches for these challenging disorders.

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Transcript

Kira Yakubov Ploshansky: 0:00

Welcome back to Heal Your Roots Podcast, cure Yakubov SHAN ski co host and we have a very special guest co host joining us today Dr. Ki Mangan, ll licensed psychologist, and a very special guest, Dr. Elissa hertz, also licensed psychologist. Today we're going to talk about the overlap between obsessive compulsive disorder and eating disorder. Ladies, thank you so much for, for hosting and for being a guest with us today.

Dr. Alyssa Hertz: 0:27

Thanks for having me.

Dr. Katie Manganello: 0:29

Yes, I'm so excited to have Alyssa on the podcast with us Dr. Hertz. Fun fact, we went to grad school together. So this is my way of being able to pull in my my colleagues that have some overlapping interests and some cool stuff to share. So I'm really excited.

Kira Yakubov Ploshansky: 0:50

So let's uh, we usually start each episode kind of learning more about the practitioner. So if you can share kind of your background, what how you got into mental health and your specific specialty? Sure.

Dr. Alyssa Hertz: 1:03

I wish I could say that it started by like, my family was a psychologist or like this strong desire to help people. But I think for a while I wanted to go into nursing school because my mom and sister were but going to college, I had no idea what I wanted to do. So I took psychology courses, and it kind of just stuck. I was like, I'm good at talking to people. And I'm good at listening to people, this is the perfect career choice. But overall, it really did start to stick, I actually found it to be really fascinating. And just seeing all the different ways you could actually use a psychology degree to help people. You know, I think from a really long time, I've always had an interest in the eating disorder route, I was just fascinated by it, just because it's a little different, in my opinion than some other presentations, right? Like, you don't need to drink alcohol, or you don't need to maybe engage in certain behaviors, but you need food to live. And the fact that people just stopped eating or kind of we're engaging these really dangerous behaviors stuck out to me a lot. So I had loved that and took a lot of courses in undergrad, my master's program like Doctor degree. And then I started having a lot of curiosity about OCD and ended up at a training site with OCD and just seeing a lot of overlap between people with eating disorders, people with obsessive compulsive OCD, and realizing that there's a lot of symptom similarity between the two of them. And I thought it could be a special training opportunity and nice to be able to say that something that I specialize in in both routes. So really, a lot of my background and training has been working eating disorders training in cognitive behavioral therapy enhanced, which is for eating disorders, and that family based therapy. And then, on the other hand, doing a lot of training in exposure and response prevention treatment as well for OCD. And then I found a job that actually married the two together, and I kind of never looked back from there.

Kira Yakubov Ploshansky: 3:17

That's awesome. That sounds really cool. Yeah. And so can you share a little bit about who you work with now and the type of population I noticed the overlap, but uh, do you see clients only for one? Or they have to have both? Or what does that kind of look like for you? Yeah,

Dr. Alyssa Hertz: 3:31

yeah. So the practice I work for, we are kind of bigger specialty was eating disorders. And we've recently kind of branched out to starting to see OCD, anxiety related disorders, PTSD, things like that, again, just because we're starting to paint this picture of the two go together pretty often. So we really, probably within the last couple of years, have started branding ourselves as a clinic that specializes in the overlap between the two now, in order to be seen by one of our practitioners, or you do not have to have that comorbid presentation. But it's kind of just like a nice option if you are struggling with both. And I think there's a lot of times to people don't understand that it's one or the other. So having someone that can relate to us as a part of, hey, you know, you actually meet criteria for this or you meet criteria for this other thing. This is how it's impacting your disorder. This is how it's impacting your presentation. So yeah, I think it just creates a kind of one stop shop for people to be able to go to. And

Kira Yakubov Ploshansky: 4:37

so for the listeners who may not be as familiar or may not know, can you kind of share what eating disorders are and some of the common subtypes?

Dr. Alyssa Hertz: 4:45

Yeah, of course. So eating disorders, they're their psychiatric conditions that cause pretty significant impairment in someone's life. And I think if we're looking at them more, I guess, generally it's really this just Intense preoccupation and fear with weight gain their their body shape their weight in this extreme desire to be able to control these things. And they're, they're dangerous eating disorders. They're they're very, very harmful mentally and physically. You know, you could go on Google and type in physical complications of eating disorders, and you're gonna get a list. You know, some of them cardiovascular issues like irregular heartbeats, people that have heart attacks, GI issues. So when we're not eating enough, there's a lot of kind of just like, not going to the bathroom regularly, a lot of GI distress. Substances abuse, people don't know how to cope with it. So they're kind of turning towards alcohol. But probably I think, you know, the other part is, like the suicidality piece. So eating disorders have highest suicide rates than any other psychiatric condition. So, you know, when we're talking about treating eating disorders, we're thinking about this fast action approach, you know, we really need to get people kind of quick into recovery. Common types, there's, there's a few you know, there's several different eating disorders, I think, probably what more people are familiar with, or have at least heard at some point in their life, anorexia nervosa, bulimia nervosa and binge eating disorder. So anorexia is just this really intense preoccupation and fear about weight gain, their thoughts and emotions that accompany food related behaviors. This leads the person to restrict, you know, they're eating significantly less amount of calories today, skipping a lot of meals and snacks that people need throughout the day. So really the hallmark feature of anorexia and I think, probably what most people are familiar with is that low body weight and we're talking about not like one or two pounds below and maybe your growth chart by your it's inappropriate for your developmental level. And that's where we see a lot of those complications start to come in. And I think that's the picture right? If you tell someone anorexia, they're thinking really thin can see like, bone structure. They don't look very well. But there's also a binge purging type as well, where people are engaging in binge episodes, which I'll explain engaging in purging episodes, but really, it's that that weight piece right, that is the defining feature there for anorexia. Bulimia is someone who repeated binge episodes. So difference between binging and overeating, we're all susceptible to overeating. You know, Thanksgiving Super Bowl, parties, we all over eat from time to time. Binge Eating is really this unusual amount of food that someone's eating in a really short period of time. That characterizes it as a binge. A lot of the times I hear people talk about, they can't control it, they've like blacked out, during like an episode of eating, they don't remember consuming all of that food. To manage a lot of the meaningfulness and distress that comes with the binge eating, they do compensatory behaviors, which basically is just a way of trying to get rid of everything that they ate. So we'll see self induced vomiting, laxative abuse, excessive exercise, and those are kind of some of the common ones. And then the last one, binge eating pretty similar to bulimia with the the binge eating periods, but there's no compensatory behavior. So they're not trying to get rid of the food. And something interesting in binge eating too, is, you typically aren't seeing this intense preoccupation with like weight shape and food as you would with some of the other ones. But there's a lot of guilt and shame that usually comes with the binge eating, that a person is experiencing. So those are probably the more common ones that I would would say. Yeah,

Dr. Katie Manganello: 9:05

Alyssa, you did a really good job of explaining those. I am wondering if you could talk a little bit more to about like, body dysmorphic disorder. I feel like sometimes that kind of gets looped in there and is something that other therapists maybe don't know as much about, like I know that I didn't know as much about that until we started at like the anxiety and OCD treatment center. So do you want to talk a little bit more about that as well?

Dr. Alyssa Hertz: 9:31

Yeah, I think a lot of people they come into treatment saying they have body dysmorphic disorder, just because there is this like, I don't like my stomach or I don't like my thighs or I don't like this certain part about my body. And, you know, again, the functionality of the two are a lot different. This person is trying to lose weight, they're trying to maintain a certain body fat percentage or whatever that looks like whereas someone with Body Dysmorphia one it's not just exclusive to maybe some of these more common areas like die stomach, you know, there's usually not like a weight loss component, it's usually this perceived flaw whether it's real or imagined, like, my nose looks too big and no one really notices that or, you know, my shoulders are too broad. And I'm thinking about, you know, when we're thinking about body dysmorphia, there's a little bit of a functionality component that's a lot different than, you know, eating disorders. If we boil these down, it comes down to weight loss and trying to manage weight and this over control like weight and shape. Whereas Body Dysmorphia is a little bit more global. It can really be anything that a person perceives to be flawed.

Kira Yakubov Ploshansky: 10:45

So it sounds like it's super specific of a body part versus like, overall, I'm not I'm unhappy with how I look and I need to lose weight, whether that's exercising like crazy cutting calories throwing up, right, those kind of things, versus kind of it sounds like obsessing over a particular body part. Yes, correct.

Dr. Katie Manganello: 11:04

Right, which is like the perfect segue into so some of the other episodes I have done with the podcast, I talk a lot about OCD. Yeah, I'm wondering if you can get your definition of OCD. And then kind of after explaining a little bit of the overlap between eating disorders and OCD, and I feel like that body dysmorphic disorder is kind of like it that in the middle type of things. So that's why I wanted you to kind of talk about that

Dr. Alyssa Hertz: 11:35

a little bit. Yeah. Well, since you've gone over it a lot. I'll try not to be overly contented about these things. But you know, OCD, the two defining characteristics are those obsessions and compulsions. So obsessions are the distressing on what thoughts images, impulses, urges, that a person that's experiencing? And the major difference? You know, when we're thinking about we all have disturbing thoughts, I'm sure anyone can think of a time they had a really weird thought they're like, Oh, God. So you know, if I'm having a thought of, I'm going to drive my car off that bridge. I'm like, That was weird. Like, I'm gonna continue driving to work or wherever it is, I'm going where, you know, the obsession ality for someone with OCD is their brain is kind of I describe it as like tagging that is, that's dangerous. That's threatening. What does that say about me? Why did I have that thought? Does it mean that I want to hurt myself in some capacity, and it kind of just gets stuck on a loop there. The compulsive side then right is a person's attempts to neutralize or alleviate a lot of that distress and anxiety. So that could be behavioral. So in that example, I'm not going to ever purchase anymore, I'm going to take the long routes, I'm going to have someone else drive, maybe it could be single prayer over a bridge and where it becomes cyclical, where it becomes a little bit problematic for people is, I say the prayer when I go over the bridge, I feel better. So then I learned, oh, all I have to do now is say a prayer in order to manage my anxiety to get over the bridge. And now I need to do it more and more and more and more, and I can't get over the bridge anymore, without saying these prayers. So essentially, the problem here is the compulsions negatively reinforced the obsessions, which essentially means that person is getting short term relief. But as soon as they encounter that trigger again, or as soon as that thing pops up into their head, again, they're kind of spinning, you know, back into that cycle. And it really boils down to this concept of a person just has trouble dealing with doubt, uncertainty, and we're trying to help them learn that they can handle some of those things. So the overlap, yes. So this is a fun question. And I really am so happy to talk about it. So you know, just to start 41% of people with eating disorders also have an OCD diagnosis. So it's not kind of just like this small thing we're almost seeing about like, half our people who who have eating disorders, most likely are having some undiagnosed or diagnosed eating disorder at the time. And think what we're thinking about it right, the the core features of both of them tend to be these obsessions and compulsions. So I will try to break it down in the best way possible by an eating disorders. Those obsessions are, you know about food, they're about their weight, they're about their body image. So how am I going to avoid eating too much when I'm at a party with all of my friends? What if I eat this slice of pizza over the weekend and I gain you know, all of this weight? What happens if I can't look in the mirror before I go out somewhere? So there's a lot of this just distressing, repetitive thoughts that happen in someone who who has experienced an eating disorder. The compulsive behaviors depend on the disorder a little bit, you know, someone who is struggling with anorexia might engage in a lot of like body checking behaviors, they might cut their food into a really small piece. says, you know, things like that. Whereas in bulimia, we're seeing more of that like purging behavior. Same function as OCD compulsions, right? There's distress, there's uncertainty about body image and certainty about food and how it correlates to weight. So I need to do something in order to feel better, I need to do something to prevent this catastrophic outcome from happening. And we kind of see that same thing in OCD. So an example to maybe lay it out is what's give a person who has OCD, they're leaving for work and they're constantly checking their purse for keys, like is it there isn't there is there take step closer the door, let me check one more time about the car luggage over time, they're trying to alleviate the doubt that there's the potential that they left her keys in the house, they don't want to forget they need to be to be certain about that. In OCD, I'm sorry, an eating disorders we're kind of seeing, you know, again, is, I don't know if I can be certain that this certain food won't cause me to gain weight, I'm gonna avoid this certain food, I need to, you know, only eat a specific diet. And when we're seeing that we're like, cool. Okay, that definitely looks more characteristic of OCD, that definitely looks more characteristic of eating disorder, but it gets really muddied. So I'll give another example. And it really help explain how when a person comes in and gives you maybe just like a symptom, were having this kind of expertise in both can help tease apart. So let's just say someone comes in and they're talking about cutting food into small pieces. I think naturally, someone's like, probably eating disorders, you know, they're cutting their food and swap pieces. I've maybe heard that somewhere before. But it could serve a lot. Yes, the the cutting of the small pieces of food could be a way of slowing down eating. So they can pull quicker, it could be to appear like, look, I eat more that's on my plate. However, it also could be, I need to cut my food into 10 pieces to prevent my mom from dying, I need to cut my food into small pieces until it feels just right. So we're seeing this kind of common symptom on the surface level. But we need to understand the functionality of it as well. Because part of the importance is that is the treatment implications for that as well. We can't apply necessarily the same treatment to that symptom. So that's kind of where it can get a little bit muddy than why it can be really helpful to understand. Is this kind of veering off into weight control body image shape? Is this kind of going into this, on preventing this catastrophic outcome, which maybe Haiti has talked about this before? It's, it doesn't make sense, I know that cutting my food into eight pieces isn't actually going to prevent anything, but I feel like I have to do it anyway.

Kira Yakubov Ploshansky: 17:53

So fascinating. I did not realize that the overlap was so pervasive, and it makes me think about, I mean, I know that in your particular practice, I'm sure there's a lot of therapists or psychologists who have this overlap, but I haven't heard really it be that common for a therapist to have both specialties, which is a little concerning, but also, right, because if it's so pervasive, and they're coming in for one or the other, how, like, how does that work? How do you commonly see whether it's with other therapists, or when clients are coming in saying, you know, I went in for initially an eating disorder and realize I have OCD who my therapist can help me or vice versa?

Dr. Alyssa Hertz: 18:32

Yeah, I think it's tricky. I think a lot of people get misdiagnosed. You know, either way misdiagnosed with eating disorder, or misdiagnosed with OCD. If a person tend to think it's an eating disorder, or let's just say it actually is a eating disorder, they're getting referred out, like nine times out of 10 people, people just don't like touching eating disorders. But I think it's either way, I think a provider either has to know a lot about eating disorders to be able to rule out the possibility that this is OCD, like I understand, again, the functionality, I understand the conceptualization of eating disorders to say, this definitely is hitting on something here and someone with an OCD diagnosis, right, is needs a provider to be able to help them really distinguish between the two, when I gave again, I think about that example, I gave it the food cutting, if you don't know, to look for underlying differences. Well, we might get into a little bit of a mess. They're not saying someone can't help them and and work with maybe whatever it is they're presenting, but you're missing a whole other piece of the disorder, possibly, or exacerbating, you know, eating disorder behavior can exacerbate OCD and vice versa. So it's, it's not that people can't get help. I just think when you have such a overlapping commonality between again serve squabble symptoms. It's a big opportunity for something to get math.

Dr. Katie Manganello: 20:05

Yeah, I think that carry back to what you were saying with I feel like a big part of it that is worth noting is that I mean, you could make that argument for a lot of disorders because OCD has its own, like comorbidities. I always kind of explain I'm like, I've got in that camp, right? Because there's, there's eating disorders, there's Autism Spectrum Disorders, there's tics, threads, body focused, repetitive behaviors, ADHD trauma. So those are all kind of lumped in with like, really common comorbidity. So I think that if you are going to somebody who specializes in OCD, they should, at least at the very least be able to get to that functionality, like Alyssa saying, and be able to at least tease it apart and give you a solid diagnosis. And then, since it's so common, I think like, for example, like obviously, Alyssa specializes in eating disorders and OCD, I focus more so on OCD and trauma related disorders. But I would say that both of us also work a lot with ADHD, right? Like, there's an end. And we also like I could work with, you know, a level of eating disorder as well. But if it's something that's more pervasive or intense, like then it's maybe something that I would say, Listen, maybe this would be a better kind of client for you. So I think that if you have a psychologist or somebody who at least knows their their diagnostics well enough that at least they'll be able to get a good diagnosis that can kind of help move them forward.

Kira Yakubov Ploshansky: 21:38

Provide you clarify that? Because I do think it's important. There are so many whom who were billed comorbidities with a lot of disorders. And it sounds like OCD is, it overlaps with so many, it's just kind of like the topic or the theme, or what else is kind of stuck on it that they're obsessing over and having these compulsions over? I mean, it sounds like your clients have the best of both worlds with you, which is really great. And that you're able to do both so well.

Dr. Alyssa Hertz: 22:06

Yeah, I mean, again, I think about a like a one stop shop, essentially is, you know, it's frustrating having to go to multiple providers, I mean, I think we can all get off big about what we've got to like our primary or something, and they're like, you need to follow up with this person, this person, this person, and you're like, I don't want to schedule all this appointment, that's really annoying. So it's nice to be able to kind of go to one spot and be able to know that you're getting a really good care for both of those things. But I also think just from like, motivation, financial, you know, finding someone who specializes in things is pretty expensive. And, you know, if you're trying to say, go see this person first, then go see this person or see two providers at the same time. That's a lot of financial commitment. That's a lot of motivational commitment. You know, it's, it's doable, of course, I don't want to give that impression that it's not doable. But I think with anything, I think we all like, if I can have just a person that does it all. Like that would be great.

Dr. Katie Manganello: 23:09

Yeah, Alyssa, like when I mean, it's not even, it's definitely more of a burden on the individual experiencing OCD, or an eating disorder, both. But I think it's also it's a lot of extra legwork for the therapist, because like Alyssa and I both like I mean, we collaborate care with other providers. And a lot of times they do, like somebody does come in with somebody that they've seen for a long time for therapy, and they want to keep that relationship for other things. But like they're here to just see us for just OCD. And like we're, it's we take time outside of notes in you know, everything to touch base with the other providers and make sure that that's consistent and that it's on the same track. So yeah, and I think that that's another reason why I love doing the podcast and getting this information out there so that it can kind of It's my little contribution and getting more people hopefully, in the know about this kind of stuff. So there's less of all of that in the long run.

Kira Yakubov Ploshansky: 24:14

And so since you treat both What are some common therapies and techniques and modalities that you use for treating an overlap of the two, what do you separate? Do you Do it all encompassing? Like what is your kind of approach and style?

Dr. Alyssa Hertz: 24:28

Yeah, so I think the first thing is, the two treatments have similar interventions, but are fundamentally different. So I think it'd be helpful to me explain how they're different and then also how they're similar. You know, so for eating disorder treatment is an example could be is I'm asking someone, okay, we're gonna go to a restaurant and you're going to pick out a food that you're you're scared of something that you feel like it's going to cause you weight, but then afterwards, it might be good distract yourself in some way go call a friend, go watch your favorite TV show send your favorite music, you know, don't sit in this forever, you don't have to, we're just kind of asking you to get over that hump of anxiety. Whereas OCD, right, we're not asking pretty structured, we're saying, You know what, you're going to sit with this distress, you're gonna sit with this uncomfortability to learn that you can manage it. And we're really asking someone to lean into their fear a bit more. So, you know, like, yeah, I might have not blown up the candle, and my house is gonna burn down, but I'm gonna day out with my friends anyway. So why it's important to know, again, I think the treatments is you can accidentally harm or exacerbate symptoms on the other end. And this is where it kind of is helpful. It also gets tricky, I think when you're working with someone with both is the interventions can be similar at the same time as well. So family involvement is huge on both ends, we always love when when family members or caregiver providers are present with OCD, family based therapy, again, it's treatment for adolescents with anorexia, parents are pretty much involved the whole way through. And I think why why caregiver involvement in general is so important is because a lot of accommodations are going on. No one ever likes to see their their loved one their child, whoever it is in distress, so we're just trying to take that load off of them, we're trying to take that burden off of them, not realizing we're making things a little bit more difficult for them. So eating disorder combinations might be getting special groceries for them, you know, not cooking with butters, or things that have fat, but it could be cooking with other things. And unintentionally, we're kind of increasing that power and eating disorder has over a person OCD might be I'm not going to hold the door for you. So you don't have to a wash all your fruits, so you don't have to touch them. So helping to reduce a lot of that family or family accommodation is really helping a person indirectly learn that they can handle some of these anxieties and challenges that they're experiencing. So, you know, I think that's a kind of intervention that seen across the board exposure. So it's a big one, you know, primary strategy for OCD work is doing exposure work, we're saying, again, do the thing that scares you the most, you know, we're going to help you get there. But that is the best way to face your fears is to do this. And we're in some respects doing that, in eating disorder work to we're asking people to see their weight, sometimes it's the first time they've ever seen their weight, sometimes it's the first time in a long time, we're asking them to not weighed themselves so much in and of itself, that's an exposure. We're asking them to eat foods that they've cut out of their diet, or they're really scared of because they think it's going to gain weight. So the the exposure piece is really, really helpful across a course in OCD, because that pretty much is the treatment, but applying that intervention over and so the eating disorder work actually has been really, really beneficial for a lot of people. And then I also think, just like the hierarchy piece, too, is you're gradually having these people confront those things and reduce certain behaviors that are problematic in a way that, in my opinion, fosters a lot of self competence. You know, you're tackling these things at a minimal anxiety rate and you're feeling good about it, when you overcome it, you feel like you could tackle that next one. Definitely think it helps with the motivational piece. And by the time they get to that top scary thing, which could be petting a dog or gaining 30 pounds, it just doesn't feel so harmful or scary anymore. So I definitely think having a lot of common interventions is helpful, but also can make it tricky at the same time as when to apply versus when to apply it as well. Yeah. Yeah,

Dr. Katie Manganello: 29:02

that kind of segues into another question that I was thinking about in terms of like, what do you think, are some of the most challenging aspects of treating clients have both?

Dr. Alyssa Hertz: 29:13

Yeah, that's a that's a really good question. I think one of the more challenging aspects is actually helping the person to understand their symptoms, you know, really understanding I personally believe, spending a lot of time on psychoeducation upfront, I don't think there's any benefit in here's what OCD is here. But neither disorders like alright, let's jump into treatment and like, I want people to feel like I know exactly how this works. I know exactly what this like cycle looks like or, or what's happening on this end. And I think one of the challenges is really helping a person start to tease it apart on their own. Really understanding okay, this is definitely coming from eating disorder mindset over here. This is coming from an OCD mindset over here. I think The other pieces is kind of what I just said is when to apply the strategies, you know, we might say, again, practice deep breathing or practice relaxation strategies, eating disorder. But if it's OCD, we don't practice it. I think for kind of a safer route, if I a person got sure I'm just like, pretend it's OCD, then the worst case happens is you sit with distress, you sit with anxiety, it goes down anyway, the outcome will pretty much be the same if you're not sure. But I think that's pretty much the hardest part is I think there's just a lot of, we need to understand your symptoms, we need to know how they play out and like potentially where they're coming from in order for us to effectively treat them along the way.

Kira Yakubov Ploshansky: 30:46

So it sounds like a very thorough beginning, right, like intake process, understanding what's going on for them what their life looks like, their family made me think about an episode with Katie, of how their family can be involved. And it almost feels like, you know, counterintuitive of like, not enabling them, like doing things outside of what would relieve that stress and anxiety so that they can actually do it on their own. So it sounds like a lot of these things are are difficult, contradictory, but then also kind of mesh well together as well. Yes,

Dr. Alyssa Hertz: 31:17

yes. And that's hard to explain to people is, this contradicts itself, and is anytime it works for backwards. And they're kind of just like, white. But I think once people really get the hang of it and start to again, learn more about themselves and their symptoms and how they manifest it becomes a little bit easier along the way.

Kira Yakubov Ploshansky: 31:39

Do you have any success stories or kind of being able to walk somebody who has an overlap? And like, what progress would look like? Or what healing would look like for them? If it's not someone in specific?

Dr. Alyssa Hertz: 31:51

Yeah. So a while ago, I worked with someone who came in for anorexia. And, you know, I think one thing I should have mentioned is, regardless of what the person is going through, if they are underweight or mounters, that is the top priority. You know, you just can't do treatment, if someone from a medical standpoint is is not healthy. But also thinking about, if you've ever tried to do something, when you're starving, it's not easy to concentrate, it's not easy to take in information. So her and I really worked on like that weight restoration piece first getting her to a healthier weight, so we could engage in treatment, and a lot of her, you know, symptoms from an OCD perspective, were around fear that she could like ingest something that were would like, change her body composition and lead to all of these like weight related changes, she was kind of the example I was leading into with like, the cutting, there was also like a piece of like, I need to cut certain foods in order to prevent like choking, or like accidentally throwing up because she was averse to throwing up. We did a lot of exposure work to like feared foods and stepping on the scale and things like that. And I mean, I would say from start to finish, it was definitely a bumpy ride. This person had not previously known that they had an OCD diagnosis and having to really go through a lot of that, not backward. But hey, there's this other thing here that that I think is actually making, you know, the IDI center a little bit worse, and potentially exacerbating a lot of these symptoms, we really need to tease this apart a little bit and treat the two more simultaneously together. And I think that ended up opening up like a whole different door for us, like treatment went so much more smoothly. I'm talking about probably for like, three to four sessions. We were like, should we be doing this anymore? Like I think we're at a standstill, like what do we do here? And I think for this person in particular is we were totally minimizing something else. We didn't realize this other thing was going on and just kind of having that extra knowledge and being able to treat some of those OCD symptoms allowed one some of the eating disorder behavior to come down to some degree as well. But we were alleviating a lot of stress and anxiety on some other end. But yeah, I mean, she well, I don't see her anymore. I haven't heard from her. So I'm assuming that she's doing really well and has moved on with things but it was a really cool example and I bring her up because she was the first person I saw with OCD and eating disorders and that's where I was like, oh, okay, these two really do coexist and there's such a symptom overlap here and not in the way again, we're thinking about like OCD behavior is over here and eating disorders here but like a lot of food related OCD. 80 obsessions and compulsions that made it tricky.

Kira Yakubov Ploshansky: 35:05

I bet that sounds Well, I'm glad you were able to help her. And that kind of sparked your interest and inspiration into wanting to delve deeper into it.

Dr. Alyssa Hertz: 35:13

Yeah, it was a very interesting and fascinating case.

Dr. Katie Manganello: 35:18

Was it? Do you feel like there's any common misconceptions about OCD or eating disorders that you think need to be addressed in the therapy community?

Dr. Alyssa Hertz: 35:28

I think there's a lot of

Dr. Katie Manganello: 35:31

timing for sure. with OCD. Yeah,

Dr. Alyssa Hertz: 35:32

we could probably do a whole nother

Dr. Katie Manganello: 35:37

while this question could be a whole episode,

Dr. Alyssa Hertz: 35:40

be a big one. Yeah, I mean, these probably are repeated. And these are probably things that are very much out there. But, you know, just the idea that like OCD is being characterized, this is personality trader, this unique quirk that people have, you know, we hear it all the time of so OCD. I'm so OCD for this. And it minimizes, in my opinion, what someone with OCD is actually going through, you know, they're struggling, they're suffering, some people are homebound, they can't leave their houses or function on their own anymore. That's not pleasant. You know, when something's describing, I'm so OCD, it's usually I like cleaning until it's begun span, or I like organizing until it looks a certain way. And that's different. But, you know, if you like it, it's not a disorder. You're enjoying engaging in this. And I think, more than anything, it's, it's just, I can't imagine as a person if I was struggling with OCD to hear people throw around that term, so loosely, and knowing what the struggle actually looks like. I think the other the other big one that comes up for me is what OCD is, you. And I think this goes into why it can be so missed, like most people aren't actually getting treatment for like 10 years when they have OCD. Like there's a huge gap in there. And there's probably other reasons in there as well. But you have the people come in and like why don't wash my hands or I don't clean stuff for I don't organize stuff. And really helping people to understand OCD is so much more than just hand washing or taking long showers or being overly clean. But we have harm OCD, where people are afraid of hurting themselves or other people or we have scrupulosity, and religious and I know Katie did a whole wonderful podcast on that. And, you know, OCD is really anything that you care about, if you care about it, it's gonna go after it. And I'm really helping people to see like, it's, it's pretty broad. And that's why people symptoms can be so all over the place when you're working with them. But I think those are probably two of my biggest one, then I think in more of the eating disorder context, I think one of the bigger misconception is people think that there's like a choice and having an eating disorder, where, really, it's not a choice. It's a, you know, there's a lot of brain abnormalities that are happening, people are kind of born with these abnormalities that predispose them to eating disorders. And I have a great example is I had a patient who was just sick, like, blue or something like that. And she just lost a bunch of weight because she was sick and couldn't eat. And when she recovered, she was anorexic. All it took is her to lose too much weight and then flip switched on in the brain. And she was in treatment for anorexia. So, you know, I highlight that as a, she didn't choose to get sick. And she certainly didn't choose to recover with now a whole another problem on top of her. But they're really, you know, difficult disorders. And I always kind of lightly say, with my patients, I'm like, there's a good chance that you didn't wake up one day, just say, I want an eating disorder. I want to, you know, really struggle with all of this. It's just not something that you ever hear. The other one, I think that can be a little disheartening to it is parents think it's their fault. It worked with parents all the time. They're like I did something, I caused this to some capacity. I made a comment to you know, back 10 years ago about something and it's really difficult to help parents really externalize that, that eating disorder from their childhood and say, You didn't actually do anything, you didn't cause this eating disorder to happen. You didn't do anything that made this happen. It just biologically predisposed, we have environmental factors, society, that could also be a whole nother podcast on society and how it plays into eating disorders. And I think really helping people understand that there's nothing you did or said that cause someone to have an eating disorder. It's just kind of a perfect combination, a perfect storm of all of these factors that had come together to get your child sick. And you're part of that like medicine, if you will to helping them get better rather than the problem.

Dr. Katie Manganello: 40:11

I like that reframe. That's really good. Yeah, yeah, part of that medicine. Another one that I like was just thinking about as you're talking to that really bothers me is I think a lot of people think that like, you don't have an eating disorder, unless you're like, sick, then like it, people in larger bodies can also have eating disorders as well. And like that can be really harmful to people. Absolutely.

Dr. Alyssa Hertz: 40:36

Again, when we probably close our eyes and think about eating disorders, I think, everyone, I shouldn't say everyone, a majority of people would probably pick the anorexic person. And treatment gap here, right is this is why people don't often get treatment for eating disorders right away is people with binge eating disorder, could be normal or overweight, people with bulimia could be average weight, a little bit underweight, they could be overweight. But because we don't meet that stereotypical idea of what an eating disorder looks like, people are like, I'm fine, I'm not actually sick, or no one's noticing, I could still fit in all my clothes, I can still do all the things that I'm doing. It can mask itself, you're still functioning, you're still looking outwardly healthy, but internally, you know, mentally you're you're struggling, I think that's a really good one, it's still really hard to break people away from that misconception of outwardly, what it looks like it's a little bit silly it is to just diagnose someone street outwardly to have you know, you do or don't just because of your body composition.

Kira Yakubov Ploshansky: 41:49

Of that's such a great point. And it sounds like just thinking about all these different practitioners, right, like not knowing some of this or you know, like quick snap judgments. Is there any piece of advice that you could give clinicians who may not specialize in one or either that can give them something to kind of look for a differentiate, just to kind of stand out in that way?

Dr. Alyssa Hertz: 42:13

Yeah, I mean, definitely, like, ask all the questions, Katie, and I, you know, she mentioned collaborating with other providers. And I think there's more people out there that are willing to help and help you understand, because, after all, we all got into this field to like, help people, we're trying to get them through to the end of that treatment, recovery road. And we want to be able to provide any insights or resources or helpful stuff. So I think, you know, connect with people in either community, whether you are unsure if you're going to go into that route, or you might end up working with people this way is just immerse yourself into OCD eating disorder community, reach out to people, I get emails for people, like undergrad schools or like Training Master levels, and they're like, Hey, I'm really interested in this, like, can you talk? And I'm like, Absolutely, I would love to help. And there's so many free webinars, talks, resources. If you have the money, conferences, just even just attending as a person to walk through and learn about all of these things. There's so many opportunities out there that are accessible, easy, affordable, for you to be able to learn a little bit more about eating disorders or OCD. And even you know, I'm attending a free hour talk on the comorbidities between the two, you know, it's just kind of looking around and finding those opportunities and jumping on them. What

Kira Yakubov Ploshansky: 43:50

a wealth of knowledge. Thank you so much. This has been super informative. Before we hop off, are you can you share if there's any resources for individuals struggling with these things? Or any kind of tidbits or advice for someone who might be struggling with both of this?

Dr. Alyssa Hertz: 44:07

Yeah, I mean, I have definitely a bunch of resources. And I'm going to selfishly plug the book that my owners of the practice did, it is on how to treat comorbid, eating disorders and OCD. It's actually really, really helpful. It goes through everything we talked about, about what you knew disorders are, what OCD is, what the treatment similarities, differences are how to treat people case examples. It's a really, really helpful book. In terms of resources for for eating disorder community, there's the Academy for eating disorders, which is great. That's where a lot of the conferences come from. There's huge networking events that you could attend from there. There's National Eating Disorder Association, Nida. They are constantly doing events like walks like I think they do a eating disorder recovery walk in ever. Every major city you know, Throughout the year, and they're constantly doing advocacy or volunteer opportunities to get involved. You know, so those are feast is Another eating disorder website for individuals who are suffering with anorexia. And we're like a parent resource, I think, to help them figure out how to manage a child with an eating disorder and just some helpful resources there. And then, of course, there's some really good books. There's the treatment manual for anorexia. There's Chris fairbairns, CBT, manual for eating disorder. So there's a lot out there on the OCD front, I think, the iocdf, which is their big international webpage for everything and anything I pretty much always refer people there when they're looking for resources or books or anything. I'm like, here, here here. I think there's a lot of good researchers and people who have a lot of published books. There's John Grayson, who has like one of my favorite books, freedom from OCD, that was kind of like my training book, if you will, to get into OCD. There's Eric Stewart, who does a lot of research and constantly doing studies for people. Eli Liebowitz, John Abramowitz, John Hirschfeld, there's so many good people that just keep pumping out a lot of helpful books and resources. So it's pretty easy to find that which is

Kira Yakubov Ploshansky: 46:34

we will definitely list all of these in the show notes. That was Yeah, fantastic. Thank you. You have so much knowledge and expertise on this. I'm so happy you were able to join us today. This was incredible.

Dr. Alyssa Hertz: 46:45

I'm so happy you guys asked me to come this is a lot of fun. So

Kira Yakubov Ploshansky: 46:49

if anybody wants to work with you, fine. You can you share where they can get in touch with you.

Dr. Alyssa Hertz: 46:54

Yes, so I work for the Center for hope and health. So easy enough to just kind of plug onto into Google. There is phone number there's an email I specifically work out of in Texas for people who might be interested in more that area, but I also have a license that allows me to practice across state borders as well. So whether you're in New Jersey, PA, Oklahoma, you know, whatever it might be is they can still reach out to that number and if they're looking for resources or treatment, that's how they can reach me. If

Kira Yakubov Ploshansky: 47:35

you've enjoyed this episode, please like, share and subscribe. Liz, thank you so much for being on Katie. Thanks for being our co host. This was a phenomenal episode to wrap